By Rosemary Hickman, December 2006

He had no medical training but the former goatherd became a key member of a pioneering surgical team

Hamilton Naki stood at the stainless steel operating table in his green surgical gown and white rubber boots. As he picked up a scalpel with a big hand, the trainee research surgeon beside him craned his neck.

The bright theatre light shone on Hamilton's broad forehead and his expression turned serious as he bent towards the abdomen that lay exposed under blue drapes. Without the slightest pause he started slicing with his scalpel from below the chest towards the abdomen until he had made a deep cut almost 30 centimetres long.

His enormous hands gently moved the bowel out of the way so that the abdominal cavity lay open in front of him. He started cutting through the tissue around the liver and his long, strong fingers danced over the veins and arteries that had been cut loose, clamping and tying them. When at last only the main blood vessels connecting the liver were still intact, he replaced the bowel and covered the incision with a sterile drape. "The pig's liver is ready for transplant, Mama," he told me. The trainee surgeon's eyes widened in surprise as he realised that Hamilton was not the principal surgeon. Indeed, the tall Xhosa man from an impoverished rural region had never even been to medical school and had only about eight years of the most basic schooling. Everything he knew he had learnt, as he put it, "by stealing with my eyes".

I was associate professor leading the surgical research team at the University of Cape Town and for 30 years Hamilton was the person I most relied on in the laboratory.

He had got his first job at the university as a gardener. But one day he would be a member of the pioneering surgical research team that paved the way for one of the most important moments in medical history – the first human heart transplant. Although I was surrounded by highly skilled medical professionals during my career as a surgeon, it was Hamilton who taught me some of the most precious things I knew: patience, modesty, grace and diligence against the worst of odds. And from this man, who had no formal education, I also learnt what the most precious thing is that we can leave behind.

Barefoot: Hamilton was born in 1926 in the remote area of Centani in the Eastern Cape. He grew up wearing goatskins and running barefoot over the rolling green hills, herding cattle and goats.

His family was very poor and when he was about 16 he had no choice but to drop out of school to find a job to help support them. He hitchhiked more than 900 kilometres to Cape Town and found a job at the university as a labourer. For the next few years his job was to roll the grass tennis courts.

The courts happened to be on the campus of the fledgling medical school. One day a professor, Robert Goetz, was about to open up a dead giraffe to find out why these animals didn't faint when they bent their long necks to drink water. He needed a pair of strong arms to help, walked outside and called the strapping young gardener into the lab. Goetz's pioneering post-mortem revealed that giraffes had one-way valves in their veins that stopped all the blood from rushing to the head when they bent down.

Hamilton stayed on to become Goetz's right-hand man in the lab. He absorbed knowledge like a sponge, learning to anaesthetise animals, different ways of cutting and stitching and how to set up drips.

Then, in 1958, Hamilton got his second lucky break. Dr Christiaan Barnard, who would one day be world famous for transplanting the first human heart, came to the research lab and pioneered his open-heart surgery on stray dogs. This research would become Barnard's lasting legacy and hundreds of thousands of lives would be saved.

A few years before his death in 2001 Barnard said in a documentary: "I saw that Hamilton was a surgical assistant with a lot of skill and gave him more and more to do. Before we did the first human heart transplant, we did 48 heart transplants on dogs. Eventually he could do a heart transplant sometimes better than the junior doctors who came here."

Then Barnard made a remarkable comment: "Hamilton probably had more technical skill than I had. If he had had the opportunity, he might have become a great surgeon." It's difficult to describe surgical skill. Yes, you need dexterity and precision, but the best surgeons have an indefinable something, best described as an intuition or an instinct. Hamilton had it.

When Groote Schuur Hospital was thrust into the world spotlight with the first human heart transplant on December 3, 1967, one of the people closest to Barnard in many of the photographs was a smiling Hamilton. Although Hamilton had not been involved with the actual human transplant, Barnard considered him a valuable member of his research team.

Overnight, Cape Town became the epicentre of the medical world. But one day a young researcher from Europe treated Hamilton in a very disrespectful manner and Hamilton, who would not accept treatment like that, asked for a transfer to another lab at the university.

Liver research: That was when Hamilton and I started working together. When I put my hand out, Hamilton would already be waiting with the correct instrument. When I stitched up animals, his hand would be right behind mine, maintaining the tension of the silk thread. He called me "Mama", an expression of great respect from a Xhosa man.

It was the early 1970s and we were doing research on liver transplants, which are far more intricate than heart transplants because the liver is such a complex organ. Hami, as we called him in the lab, took to his job with ease. One day he called me over: "Mama, look at this. This hepatic artery has an extra branch." I was astonished. He had noticed the unusual artery going to the liver and called it by its correct anatomical name. Very few medical students with some anatomy training would have recognised this. I would often be struck by his ability to remember all the correct anatomical names despite his limited education.

Over the years this man would teach generations of surgeons surgical skill in the only way possible: by showing them. Many brash know-it-alls swaggered into the lab, but every time they fell silent, sensing that they were watching a master at work.

He had the ability to do many things at once. He could assist surgeons, watch a monitor, keep an ear out for the anaesthetic and sometimes rock my baby's crib, all at the same time. Once I heard squeals of laughter coming from a huge cardboard box which had contained a piece of lab equipment. Hamilton had made a playhouse and was crawling around inside it with my little daughter.

Many of those surgeons who learnt from Hamilton would go on to become professors and top surgeons all over the world. He was often credited in their academic papers. Hamilton was not intimidated by anyone. Dr Brian (Benzy) Cohen who now runs the national fertility centre in Texas, was performing an intricate operation on a pig's main vein. As he was completing the procedure he was about to put in another stitch. Hamilton – who had done the operation many times – said: "Benzy, that's enough. Tie it off now." Believing that an extra suture would stop any bleeding, Cohen proceeded and the operation was a failure. The next time, Cohen recalls: "When Hamilton said, 'Benzy tie it off' my immediate reply was, "Yes Hamilton" and I tied it off. I learnt immediately that here was a man who understood vascular surgical technique better than anyone else."

When there was a quiet time in the lab, Hamilton would read his Bible or be down in the cemetery where vagrants met. I would often see him sitting on a bench, trying to influence them, sometimes successfully.

Township riots: In 30 years Hamilton almost never missed work, even though the apartheid riots of the 1980s often disrupted public transport. Sometimes he would leave before the blockades had been put up in the townships and be at work by 3am. Although I'm sure he often had to walk long distances, he arrived at work every day at 6am, his large frame dressed in a sharply pressed suit, tie, hat and sparkling shoes. Through those difficult times he kept a good sense of humour. A young surgeon asked him: "Hamilton, if the riots break out here, will you shoot me?" Hamilton looked at him in his dignified way and said: "No, but I'll ask someone else to do it."

Although South Africa's apartheid policies had dictated where Hamilton could live and which school he went to, he took offence at the idea that because he was black he couldn't get anywhere. Hami didn't work like that. He never saw himself as a victim of anything. He had made use of the opportunities he had and never failed to share what he learnt. He had the same humble attitude as Nelson Mandela, also a Xhosa from the Eastern Cape.

In 2003, the University of Cape Town made an extraordinary announcement. For the first time in its history a man who had never finished school would receive an honorary Master of Medicine degree. The man who started working there as a gardener more than four decades before walked down the aisle of the graduation hall where legions of students before him had received their degrees. Hamilton, looking stately in a dark suit, stood erect and motionless on the stage as David Dent, Professor of Surgery, read the citation, describing him as "an extraordinary teacher and surgical craftsman".

As he read the words "the university honours a man who taught the craft of surgery to so many", Hamilton stepped forward. A thousand students and academics burst into applause.

A photograph of that day had pride of place in Hamilton's modest house in the suburb of Langa, next to one showing President Thabo Mbeki awarding him the Order of Mapungubwe in bronze, for service to the nation.

I last saw Hamilton just before Christmas 2004. We sat in his living room, updating each other on our families as his children and grandchildren ran in and out. The family's involvement in medicine goes on: his daughter Vuyokazi is a nurse in Cape Town.

On a sunny Cape Town winter's day in June 2005, Hami's family, friends and former colleagues gathered in the old lab, now closed. He had died a month before, aged 78, and lay buried in the green hills of the Eastern Cape that he had loved so much.

Surgeons, professors, doctors and lab assistants all shared their memories of him. Anwar Mall, an associate professor of surgical sciences, captured the essence of how we all felt: "Hamilton Naki was a giant. When I grew up, Chris Barnard was my hero. But as I became older, I realised people like Hamilton were the real heroes." That's when I realised that the most important measure of our lives is not public recognition, but the legacy we leave behind, the people we've touched and the way in which we did it.

As told to Judy van der Walt

Image: Hamilton Naki received an honorary degree from the University of Cape Town in June 2003, along with the Archbishop of Cape Town, Njongonkulu Ndungane (left), and theatre impresario and Aids activist Pieter-Dirk Uys (right).